Oluwaseun Odutola

Primary specialty

DentistTaxonomy code 122300000X

License

062186 Issued in NY

Practice address

4754 Commercial Dr Ste 2
New Hartford, NY 13413-6205

Phone

(315) 768-7799

NPI assigned

Apr 28, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638576000000",
    "number": "1164043410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4754 COMMERCIAL DR STE 2",
            "city": "NEW HARTFORD",
            "state": "NY",
            "postal_code": "134136205",
            "telephone_number": "315-768-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4754 COMMERCIAL DR STE 2",
            "city": "NEW HARTFORD",
            "state": "NY",
            "postal_code": "134136205",
            "telephone_number": "315-768-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODUTOLA",
        "first_name": "OLUWASEUN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-28",
        "last_updated": "2021-12-04",
        "certification_date": "2021-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "062186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE STUDENT RESOURCES",
            "identifier": "8131455",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sally O'Callaghan, FNP
• Linda A O'Connor, FNP
• Jamie Ann Oakes
• Abby Ruth O'Donnell Oberriter, PSY.D.
• Fahreta Odobasic, FNP
• Felix Osabohien Oduwa
• Ohlbaum & Waterman Eye Associates
• Steven Andrew Ohlbaum, O.D.
• Greg Steven Orlando, MD
• Victor R Osinaga, MD

• Dentist in New Hartford, NY
• Providers in New Hartford, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.